**1. Introduction**

Ischemic stroke is a leading cause of morbidity and mortality worldwide. Common etiologies of ischemic stroke include cardioembolic events, intracranial arterial stenosis, extracranial large vessel dissection (spontaneous and traumatic), genetic or familial causes such as Moya-Moya Disease and fibromuscular dysplasia, and carotid artery stenosis. The latter is respon‐ sible for a significant percentage of ischemic strokes due to carotid atherosclerotic disease and will be the focus of this chapter. Diagnosis is often made based on physical exam by the primary care physician and routine ultrasonic or radiographic screening. Detection of carotid artery stenosis typically results in the eventual referral to a general vascular surgeon or a cerebro‐ vascular neurosurgeon when revascularization is indicated for intervention. Selecting candidates for medical treatment or revascularization is guided by data obtained from excellently performed trials including the *North American Symptomatic Carotid Endarterectomy Trial (NASCET)* and the *Asymtomatic Carotid Artery Stenosis (ACAS) Trial*. Treatment depends upon the severity of carotid stenosis and the absence or presence of stroke symptoms. Medical management, carotid endarterectomy, and carotid artery stenting with angioplasty, each have important roles in the appropriate treatment of carotid stenosis. It is the surgeon's responsi‐ bility to assess the patient's history, physical exam findings, imaging studies, and risk factors, to make appropriate recommendations on the best treatment for the patient at hand. The purpose of this chapter is to review the management of atherosclerotic carotid artery disease based on available data in the literature and to provide information useful in daily practice.
